Advancing the Agenda of UHC

The healthcare sector in India is largely underpenetrated with government expenditure around 1.4 percent of the GDP, as against the world average of 5.9 percent. The Out of Pocket expenditure for the country accounts for a staggering 62 percent of the total healthcare spend against a world average of 18 percent. Prefinanced expenditure in healthcare currently stands at a meager 8 percent for India, as against 41 percent in the US and 45 percent in South Africa. Combined with the high medical inflation, this makes a large section of the population susceptible to healthcare shock.

The National Health Policy 2017, released after a gap of 15 years has attempted to address this. A major commitment has been made for raising public health expenditure progressively to 2.5 percent of the GDP by 2025. The government will need to further increase the health expenditure of Rs. 623,663 crore by 2024-2025, in tandem with the present growth rate; how it will achieve this herculean task is worrisome. To kickstart this, the government has made a provision of Rs. 47,352.51 crore to MoHFW under the Union Budget 2017-2018, a 27.7 percent increase over previous year’s allocation.

The National Medical Commission Bill 2017, replacing the Medical Council 1956 Act, approved by the Cabinet on December 15, 2017; shall enable a forward movement in the area of medical education reform. The Medical Devices Rules 2017, which will be implemented from January 1, 2018 have eased norms for obtaining licenses and conducting clinical trials, and also reduced the manufacturer–regulator interface by prompting a digital platform. These harmonized policies and rules for medical devices will also encourage local manufacturing and move toward improving affordability for patients.

Having said this, the year did not see a Medical Device Authority. A complex regulatory environment continues to plague the industry, disproportionate reliance on imports continues, indigenously manufactured products get no preference in public procurement, a single window clearance and an indigenous quality certification authority continue to be on the wish list. We have mountains to climb before we can claim to be anywhere near solving the three issues of UHC: access, quality, and cost!